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A SAFETY & BUILDING
`DEPARTMENT OF INDUSTRY, INSPECTION REPORT FOR DIVISION
LABOR & HUMAN RELATIONS ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION
P.O. BOX 7969 State Plan I.D. Number
MADISON, WI 53707 (If assigned)
❑
S,NE4fSeC.16.T28-R19 CONVENTIONAL ALTERATIVE ❑ Mound
Town of Troy Lot ~ Ho ing ank ❑ In-Ground Pressure INSPECTION DATE:
AMARd L•DER: ADDRESS OF PERMIT HOLDER:
. CST REF. PT.ELEV.:
Terr F1ancY]A Rt • 3 Box 162 E River F IS WI REF. EL
BENCH MA K (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN:
/O ~ GC~.O
C n { c 7~1f r° ri t,
~ "M~"~ '~F1c_f ^ ^}r l' a County:' Sanitary Permit Number:
MP/MPRSW No.:
Name of Plumber:
Paul C.J. Steiner 6780 S C 128929
-7 1,F jj_ a/ _ /02. 34 s4 COV
SEPTIC TANK/ TANK INLET TANK OUTL LEV.- WARNING LABEL LOCKING :
MANUFACTURER: LIQUID CAPACITY: I PROVIDED: PROVIDED:
1vl ~g' 7 7 ES ❑NO ❑YES NO
WELL: BUILDING: VENT T ESH
.1e v I ROAD: PROPERTYWdF
AIRINLE
BEDDING: C_0, GMAT ALAR MATER LINE:
FEET FROM
❑ YES NO [mot K Cs ❑ YES NO NEAREST
DOSING CHAMBER: WARNING LABEL LOCKING COVER
DEL: PUMP/SIPHON MANUFACTURER: PROVIDED: PROVIDED:
MANUFACTURER: BEDDING: LI ❑ YES ❑ NO ❑ YES ❑ NO
NO PROPERTY WELL: BUILDING: VENT TO FRESH
PUMP AND CONTROLS OPERATI L: NUMBER OF LINE: AIR INLET:
GALLONS PER CYCLE: FEET FROM
(DIFFERENCE BETWEEN ❑ YES ❑ NO NEAREST
PUMP ON AND OFF L DIAMETER: MATERIAL AND MARKING:
SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORK E
or excavation. (If soil can be rolled into a wire, construction shall cease until
the soil is dry enough to continue.) Q ~bh5 I 5 ~C-r
LIQUID
CONVENTIONAL SYSTEM: INSIDE DIA.: PITS: EPTH:
D
WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: OVER PIT
BED/TRENCH _ # TRENCHES: i
PROPERTY WELL: BUILDING: VENT TO FRESH
DIMENSIONS )(IO r~~l A,-
AIR INLETS TR. NUMB GRAVEL DEPTH FILL DEPTH DISTR. PIPE DISTR. PIPE DISTR. PIPE MATERIAL: P PES' FEET FROM LINE:
BELOW PI DES: ABOVE COVER: ELEV. INLET: ELEV. END: q'~,~s V.!', $t..~ , y U
r NEAREST'~~
MOUND SYSTEM:
Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM
slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW
ED YES ❑ NO meets the criteria for medium sand. ELEVATIONS MEASURED.
PERMANENT MARKERS OBSERVATION WELLS;
SOIL COVER TEXTURE:
-1 NO
❑ YES ❑ NO ❑ YES
SEEDED: MULCHED:
.
. OVER TRENCH/BED- - DEPTHS OF TOPSOIL: SODDED:
DEPTH OVER TRENCH/BED DEPTH .
CENTER: EDGES: - - ❑ YES ❑ NO ❑ YES ❑ NO ❑ YES ❑ NO
PRESSURIZED DISTRIBUTION SYSTEM: FILL DEPTH ABOVE COVER:
BED/TRENCH WIDTH: LENGTH: NO. OF S: LATERAL SPACING: GR EL DEPTH BELOW PIPE:
DIMENSIONS
MANIFOLD PUMP MANIFOLD DISTR. PIPE MANIFOLD MATERI NOESSTR. DDIS ISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKI
ELEV.: ELEV.: DIA.: ELEV.:
ELEVATION AND VERTICAL LIFT CORRESPONDS TO
DISTRIBUTION COVER MATERIAL. APPROVED PLANS
HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY:
INFORMATION ❑ YES ❑ NO E:1 YES El NO
BUILDING:
PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF LINE:
COMMENTS: FEET FROM
~Q I t ❑ YES ❑ NO ❑ YES ❑ NO NEAREST
c,~ CG'u✓C `f,'t 17 r.'~.
S e- /_101
c t
'c
1 ~C rr, r Gil. o '
Y x,45 6,,at.
tain county file for audit.
Sketch System on SIGNATURE: TITLE:
Reverse Side.
SBD-6710 (R. 06/88)
SANITARY PERMIT APPLICATION ~o~N
IEDILHA In accord with ILHR 83.05, Wis. Adm. Code OUN
STATE SANITARY PERMIT
-Attach complete plans (to the county copy only) for the system, on paper not less than
8% X 11 inches in SIZ@. ❑ c~eH$ n tovi us application
STATE PLAN I.D. NUMBER
-See reverse side for instructions for completing this application.
1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATIIOON..ERTY LOCATION
PROP OWNER 14 L Y4, S T Ae, N, R
Q OT # BLOCK #
PROPEAVWN R'S MAILING ADDRESS 3Z
o l
CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER a= Q~
Jr y z 1t 1 ? 6
S NEAREST ROAD
125 errr II. TYPE OF BUILDING: (Check one) ❑ State Owned
rIN ~ p 1 D e
❑ Public n1 or 2 Fam. Dwelling-# of bedrooms -PARCEL TAX NUMBER(
III. BUILDING USE: (If building type is public, check all that apply) D 70 - 1.2 / Y -/6
1 ❑ Apt/Condo ❑ Outdoor Recreational al Facility
20 Assembly Hall 6 ❑ Medical Facility/Nursing Home 10 11 El OutdoRestaurant/Bar/Dining
Recrea 3 11 Campground 70 Merchandise: Sales/Repairs 12 El Service Station/Car Wash
4 ❑ Church/School 9 80 Mobile Home ❑ Off ice/Factory ark 13 El Other: Specify
5 ❑ Hotel/Motel
IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) air of A) 1 ® New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Ex Reconnection of sting
System 5.0 Rep Existing System
System System Tank Only
Date Issued
B) ❑ A Sanitary Permit was previously issued. Permit # -
V. TYPE OF SYSTEM: (Check only one)
Other
Non-Pressurized Distribution Pressurized Distribution Experimental 41 ❑ Holding Tank
11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type
42 1:1 Pit Privy
12 Seepage Trench 22 1:1 In-Ground 43 ❑ Vault Privy
13 Seepage Pit Pressure
14 ❑ System-In-Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. (Min./inch) RATE L6. SYSTEM ELEV. 7. EFINAL LEVATION GRADE
REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gs I ~ Y/sq ft) 9% eet Feet
VII. TANK CAPACITY 6 Site Fiber- Exper. in alIons Total # of Manufacturer's Name Prefab. Concrete Con- Steel Plastic
glass App.
INFORMATION New istin Gallons Tanks strutted
Tanks Tanks
Se tic Tank / :~11
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached pla B
Plu Signature: No Stamps) MPtMPMW No.:
Plumber's Name (Print): usiness Phone Number:
y►j1~~
C Skein e dV
Plu eAddress (Street, City, State, Zip Code): e
Wo .e I v r
IX. COUNTY DEPARTMENT USE ONLY ►ssuin Agent Signature (No Stamps)
❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e ssue
Surcharge Fee)
9(A ❑ Owner Given initial / /Q _ i!QD
Adverse Determin ti n
X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL:
SBD-6398 (formerly Plb-67) (R.11/86) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new
criteria in the Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be
submitted to the county prior to installation.
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed
pumper whenever necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your focal code administrator or the
State of Wisconsin, Safety & Buildings Division, 608-266-3815.
To be complete and accurate this sanitary permit application must include:
1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of
where the system is to be installed.
II. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is Public, check all appropriate boxes that apply.
IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or
repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested in ##1-7.
VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of
tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all
septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received
experimental product approval from DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g.
MP, etc.), address and phone number. Plumber must sign application form.
IX. County/Department Use Only.
X. County/Department Use Only.
Complete plans and specifications not smaller than 8% x 11 inches must be submitted to the county. The
plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of
holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service;
streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system
areas; and the location of the building served; B) horizontal and vertical elevation reference points;
C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump
performrance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if
required by the county; E) soil test data on a 115 form; and F) all sizing information.
- - - - - - - - - - - - - - - - - - -
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of
regulated practices which can effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater, ground-
water contamination investigations and establishment of standards.'
SBD-6398 (R.11/88)
APPLICATION FOR SANITARY PERMIT
• 8TC-100
This application form Is to be completed In full and signed by the ownst(s) of
the ptopecty being developed. Any inadequacies will only result in delays of
the permit issuance. -Should this development be Intended tot tesale by
owner/contraetot,(spee house), then a second form should be tetalned and
completed when the property Is sold and submitted to this elites with the
appropriate deed recording,
-•••---•---.w.w~ww..•ww.--w.wwwwwwwww-w-wwwwwwwwwwwwwwww ww-wwwwwwwwwwwwwwwwwwww
Owner of property TERRY FLANSCHA
Location of pcopetty Na_,rl/4 N.www.~...1/1, section , 16 T 2L jI-R lL9.v
Township TROY
MallIng address -„TERRY FLANSCHA, RT. 3, BOX 162 E..
RIVER FALLS, WI 54022
• Address of alto 368 GLOVER ROAD,-RIVER FALLS, WI 54022
subdivision newts GLOVER STATION
Lot numbes _ #32
Previous owner of property DENNIS R.• SCHULTZ
Total also of parcel 2.05 ACRES
Data parcel was created 9/20/90
Ate all corners and lot lines Identifiable? Yes o
is this property being developed lot resale (*Pee house)? as x pie
Voidw» 881 _and Page Number, 618
as secotded with the Register of Deeds.
•-----..•.........•-•-•------www-w-w.-www.---..•.-wwww-wwwwwwwwwwww
• INCLUDE WITH THIS APPLICATION THE FOLLOWINGI
A WARRANTY DYED which Includes a DOCUMRNT NUMBER, VOLUMS AND PACK NUMBER, and
the SEAL OF THE REOISTER OF DEEDS. In addition, a cettltled survey, It
available, would be helpful so as to avoid delays of the reviewing process. it
the deed description references to a Cestitlsd Survey Map, the Cettllled survey
i Map shall also be required.
PROPERTY OWNER CERTIFICATION
I(ve) certify that all statements on this form ace true to the best of my (out)
Rnovledgel that I (we) am (ate) the owner(s) of the ptopecty described In
this Intotmation totm, by virtue of a warranty deed recorded In the Office of
the County Register of Deeds as Document No. #462570. l and that I (vet
presently own the proposed alts for the sewage disposal system tot I two) have
obtained an easement, to run with the above described ptopetlr, foe the
construe on of •a d system, and the same has bee d ~y eeocded in the ottiee
et the ntY Re
cot Dee t~46gL5~~
#
t so Document NO*
signature o owner 8lgnatute of Co-Owner (It Applieablej
aeots
gntuts
Date of ilgnatusa
DOCUMENT N STATE BAR OF WISCONSIN FORM 1-1982 T.I. P.C. SRESERVED FOR RECORDING DATA
WARRANTY DEED
4G2570 1 ot. 831 PAGE 613 REGISTER'S OFFICE
Dennis R. Schultz ST. Mix co w
This Deed, made between Reed for Rec.ord
S-p 211990
- -
Grantor, at 2:10 P M
and Terry---K..-- Flanscha - 0
«L Register of Deeds
Grantee,
Witnesseth, That the said Grantor, for a valuable consideration......
-
~
CTOlX
conveys to Grantee the following described real estate in St....... RETURN TO C.M. Bye,
j County, State of Wisconsin: P 0 BOX 167, River Falls
Wisconsin 54022
Tax Parcel No:
Lot 32, Glover Station Subdivision, located in the
NW% of the NW% of Section 16, Township 28 North,
Range 19 West.
TRAN'
s~
This . . . . . is not
homestead property.
OW (is not)
Together with all and singular the hereditaments and appurtenances thereunto belonging;
And .Dennis R. Schultz
-
warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except
municipal and zoning ordinances, easement for public utilities,
and building restrictions of record,
and will warrant and defen/d~ the same.
Dated this C.W.~J~ day of Se-p ber , 19.9...._. .
s
_ (SEAL) (SEAL)
* Dennis R. Schultz
(SEAL) -•----•----......----•-•-------...----....•-•-.......----•-----.....(SEAL)
AUTHENTICATION// ACKNOWLEDGMENT
Signature (s) Aawm/V-/_r.--/1-~ .6.!iltjA STATE OF WISCONSIN
83.
yy,. p county.
authenticated this .80.day OLIN.),
1990 Personally came before me this day of
, 19........ the above named
.
TITLE: MEMBER STATE BA F WISCONSIN
(If not,
authorized by § 706.06, Wis. Stats.) to me known to be the person who executed the
foregoing instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFTED BY
..r,;a1 '
C.....
.•.M-'---Bx
Attorney at Law
Notary Public County, Wis.
(Signatures may be authenticated or acknowledged. Both My Commission is permanent. (if not, state expiration I
are not necessary.) l
date: 19.......-.) I
*Names of persons signing in any capacity should be typed or printed below their signatures.
1
~ ~ STATE FORM No. 1- 19 2NSIN Stock No. 13001
H
' VI
H
' a
ST C- 105 r
a
H
SEPTIC TANK MAINTENANCE AGREEMENT o
St. Croix County z
d
a
H
OWNER/BUYER TERRY K FLANSCHA
ROUTE/BOX NUMBER 368 GLOVER ROAD Fire Number#368
CITY/STATE RIVER FALLS, WI ZIP 54022
PROPERTY LOCATION: NW 14, NW k, Section 16 T 28 N, R 19 W,
Town of TROY St. Croix County,
Subdivision GLOVER STATION Lot number #32
Improper use and maintenance of your septic system could result in
its premature failure to handle wastes. Proper maintenance con-
sists of pumping out the septic tank every three years or sooner,
if needed, by a licensed septic tank pumper. What you put into
the system can affect the function of the septic tank as a treat-
ment stage in the waste disposal system.
St. Croix.County residents may be eligible to receive a grant for
a maximum of 60% of the cost of replacement of a failing system,
which was in operation prior to July 1, 1978. St. Croix County
accepted this program in August of 1980, with the requirement that
owners of all new systems agree to keep their systems properly
maintained.
The property owner agrees to submit to St. Croix County Zoning a
certification form, signed by the owner and by a master plumber,
journeyman plumber, restricted plumber or a licensed pumper veri-
fying that (1) the on-site wastewater disposal system is in proper
operating condition and (2) after inspection and pumping (if nec-
essary), the septic'tank is less than 1/3 full of sludge and scum.
Certification form will be sent approximately 30 days prior to
three year expiration. yo
I/WE, the undersigned, have read the above requirements and agree
to maintain the private sewage disposal system in accordance with H
the standards set forth, herein, as set by the Wisconsin Depart- 10
ment of Natural Resources. Certification form must be completed
and returned to the St. Croix County Zoning ffice within 30 days
of the three year expiration date.
SIGNED
DATE
St. Croix County Zoning Office
P.O. Box 98
Hammond, WI 54015
715-796-2239 or 715-425-8363
Sign, date and return to above address.
r
DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS
INDUSTRY, DIVISION
LABOR AND PERCOLATION TESTS (115) MADISOP.O. BOX N W 53707
HUMAN RELATIONS
(ILHR 83.09(1) & Chapter 145)
LOCATION: SECTION: q NSHIP UNICIPALITY: OT NO.:BLKNO.: SUBDIVISION NAME-
~M
s$-1/ 1)E' b /TZ$ N/R I ! E (or 7-Ttoyf' 1L 3 Z - alzQm s1ri1 W "D.
COUNTY: M \-ZAL:kST ~ Z Talix !bL E
S%'• Ct2l~UC ~L~2,Q.~( ~=1.AfJSCN-Ia ~WL1L L I S 022.
USE DATES OBSERVATIONS' MADE
NO. B DBMS.: COMMERCIAL 1 ~ TESTS:
Oiesidence ~'p-
A• I~LNew ❑Replace
j 1
RATING: S- Site suitable for system U- Site unsuitable for system
CONVENTIONAL: MOUND: IN-GROUND -FILLHOLOING TANK: RECOMMENDED SYSTEM: (optional)
®S ❑U ❑ S DU 0S []U ®S U ❑ S ZU Z0-*M _ "-Ivkf.~j S'x 100' LW C,,
v)3, ta-eQb_Z dq,~C x'75 LQJVG
IGN RATE:
If any portion of the tested area is in the
If Percolation Tests are NOT re wired DES 'M
Gl, S Z 01.1
.
under s. ILHR 83.0915►(b), indicate: P'TS Floodplain, indicate Floodplain elevation.
PROFILE DESCRIPTIONS
BORING TOTAL P R UNDWAT R•INCH S ARA R S IL WITH THICKNESS, COLOR, TEXTURE, AND DEP
NUMBER DEPTH IN, ELEVATION gS V D TO BE ROCK IF OBSERVED (SEE ABBRV. ON BACK.)
B- 1 R9. 1~ k1Y~l E ? (o S ( G E Z o F Z
B- Z 8 y t oy • S t~ y tf
g y
B- 8 tom, o -2
B- 5 S S loz.~► g s
B-
PERCOLATION TESTS
TEST DEPTH, WATER IN HOLE TEST TIME DROP-1-N WATER LEVEL-INCHES RATPER INCH MINUTES
I
f NUMBER INCHES AFTERSWELLING INTERVAL-MIN.
P-
P
P- 3. tr S 6E .
P-
P-
P-
PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori-
zontal and,vertical elevation reference points and show their locatio on the plot plan. Show the surface elevation at all borings and the direction and percent
of land slope. Q 100 • s 9t.) 17-N*,e 8Z eVR-k- {'~Y $ ZF
SYSTEM ELEVATION ~~•z ®4~•°
--T- - o So' t
I 11ft IN Felt
r ~r 1r ti!
LJ `t r rr S 'r f I
Jv L'[Z L C
O _
5 B$ v o f L >„u qJ 1 S
40.
l
_ h
S ch I Its. so` eXdj_-'PT N1 3%" t:.ira 300' 5 om U:
I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin
Administrative Code; and that the data recorded and the location of the teats are correct to the best of my knq*ledge and belief.
WEGERER SOIL TESTING
NAME print : AND TESTS WERE COMPLETED ON:
9-18-90
DESIGN SERVICE ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional
P.O, BOX 74 421 N. MAIN ST. L`$"►' o(Wn S")` IS- VZS- 0/65
RIVER FALLS; WI 54022 CST SIGNATURE-
715-425-0165
J
SOIL DESCRIPTION FORM
(Attach So o a a on s soparats Shoo
`C- 1U S c 'L . 'Z S
Z.
PURPOSE:
Asrr1 c So ~Pc'S'TET~z-Ly_ -
ncscnlrrloN BY: ~`CNU' t W R
S 'PT. 18 , l 9 4 O c R AND
t=
DATr.:
v G ss - w s
OUNTY/S A C"CZ'U ~k CpUl.~T•f W
r
loT 32 0 DESCRIPTION:* GLa UeP- 51Y"Cf)~ Z"`~ t DD DRAINAGE CLASS: wL-..L 0~-kix.J
Sl= /~y_ fir, L [yr 5t-c. 1 T'2,46 AJ I a 19 w GALLONS-PER 39. FT. PER DAYt S
T ON'✓iJ OF
. SERIESt .8U~2.11'C OT- S'k E vr''L P
ARENT MATERIAL s /DEP 1' SOIL 1 . .
tKXiI10N OEP111 MATRIX COLORS MOTTLES TEXTURE STROCTURE CONSISTENCE CLAYSKass/ PORES ROOTS P11 •BOUNDARY REtlARKS
{n, nn{ t G Si. SA
~vs G 1 ~S
o-q iay>z 31Z s i l Zr,sbk w,~F'►-
Z °1-Z~/ t 0`iR Y!6 - S j)'F s~~ r1'F► S
IV -14 to~2 X116 S ° g , M _ . es
U3_ 1 ` Te- y1 S S M
S) Z..r~ b mv.~t^ gt,~. ,~GRJtV~l
~4 -21 to~tQ y 16
1c`1t?-y - s o s m 1
IL%j G
o- l0 31z- _ si 2Ms~k n1 -cs
S o s ~►I':~ 9s -
3 26-~10 lw-l.
TL 6
B~DQ, lU G ;
1WlR- l 5 i J 2msd m s
Z ) I - 3e ~o~ cz. y 1 s i 1 Z'm s~,k . rr,`F~.~ 4-S
3 30-L41 R /6 - S S aS
~ UZ-~y X0`(2 1 ~ O r'I
l3o N G
c~
o - 1u~I 1z 3 ~z - s ' 1 ZM.s >,r~ M `F" - -
Z 9-3 Z 1W ITL Y!6 - S Zm3~ m ~S
_ 3i-~16 lV Utz Lll6
X16-gs ti~~stZy! -s v vvt
OTHER SITE FEATURES/NOTES: /~~;,~Q
C79J,3 0011 S-7 f~nG~? of?
Signature Date CST t
LIMITING FAC10R5/DEPTH:
lerry Flapsch(2
5Y.5 - v.."- rev
i
;
I
;
O NpUre
I
s~
J - re4! -
f l/t / )0, o r •2 '4 bre e
/vcQwcs i~ 3 r re4
3Co L
'~G 7190
Form- STC - 104
V
AS BUILT SANITARY SYSTEM REPORT Vv
OWNER TERRY FLANSCHA TOWNSHIP TROY SEC 16 T 28 N-R 19 W
ADDRESS Rt. 3, Box 162 E ST. CROIX COUNTY, WISCONSIN
River Falls, WI 54022
SUBDIVISION GLOVER STATION LOT #32 LOT SIZE
PLAN VIEW
i
Distances and dimensions to meet requirements of ILHR.83
SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM
System Elevatio
1) 100.3-
2) 99.2' _
3) 98
)G~ rk
Rea S ~e 'v
- - l~ L
R r ea _
4'4 boo e
Ttt<
ao Z
SCALE:
1" = 50'
3ao
i _
BENCHMARK: Describe the vertical reference point used - p; k,- ► 4 7- 4 h o e
/ r e-
Elevation of vertical reference point: Proposed slope at site: ~n
SEPTIC TANK: Manufacturer: e4a, h Liquid Capacity:
Number of rings used: Tank manhole cover elevation:
Tank Inlet Elevation: Tank Outlet Elevation:
I /GG
Number of feet from nearest Road: Front, OSide,ORear,O / 6 6 Feet
From nearest property line: Front,O Side,ORear,O / 7 / Feet
Number of feet from: well &t Ih l(Q] , building:
I
(Include this information of the above pl6t,plan)(2 references dimensions to septic tank)
SEE REVERSE SIDE
= r
P CHAMBER .y
Man acturer: Liquid Capacity:
Pump Mod Pump/Siphon Manufacturer: Pump Size
Elevation of i et: Bottom of tank elevation:
Pump off switch ele tion: Gallons per cycle:
Alarm Manufacturer: Alarm Switch Type:
Number of feet from nearest pro ty line: Front,_ O Side, O Rear, O Ft.
Number of feet from 1:
Number of feet from building:
(Include distances on plot plan).
SOIL ABSORPTION SYSTEM '
Bed: Trench: X
Width: Length: Number of Lines: Area
Fill depth to top of pipe: 02 ~
i
Number of feet from nearest property line: Front, O Side, Rear, O Ft.~
Number of feet from well : )n 1~6 a)
Number of feet from building:
(Include distances on plot plan).
SEEPAGE T
Size: Number of pits: Diameter:
Liquid depth Bottom of seepage pit elevation:
Area Built:
Has either a drop box or distribution box O been used on any of the above soil
absorbtion systems? (Check e).
HOLDING TANK
Manufacturer Capacity:
Number of rings used: E1 ation of bottom of tank:
Elevation of inlet: e7
Number of feet from nearest property line: Front, O Side, O Rear, Ft.
Number of feet from well:
Number of.feet from building:
Number of feet from nearest road:
Alarm Manufacturer:
Inspector:
Plumber on the Job: i
DATED: License Number: 7 0 d
3/84:mj
,T
*COMMERCIAL TESTING LABORATORY, INC.
514 Main Street, P.O. Box 526
Colfax, Wisconsin 54730
715-962-3121
800 - 962 - 5227
C
ST. CROIX ZONING REPORT NO.' 22514/01 PAGE 1
ST. CROIX COUNTY REPORT DATE: 5/15/92
COURTHOUSE DATE RECEIVEED# 5/14/92
HUDSON, WI 54016
ATTNS TWMiAS C. NELSON
12TY~
OWNER: Ter e6lod.. LOCATIONS 368 Hudson
COLLECTORS Mf. Jenkins
DATE COLLECTEDS 5-12-92
TIME COLLECTED: 3200pm
SOURCE OF SAMiPLE'# Kitchen faucet
DATE ANALYZED25-14-92
TIME ANALYZED22200pm
COLIFORMS 0 /100m(
INTERPRETATION. Bacteriologically SAFE
NITRATE-NS 4 ppm
Above 10 ppm exceeds the recommended Public
Drinking Water Standard.
Coliform Bacteria/100 ml
Nitrate-Nitrogen, mg/L
LAB TECWICIANi Pam Gave
EdNDEVEp~E
WI Approved. Lab No. 19
d 5A t Means "LESS THAN" Detectable Level Approved by:
® PROFESSIONAL LABORATORY SERVICES SINCE 1952
w
ST. CROIX COUNTY ZONING OFFICE
J f St. Croix County Courthouse
911 4th Street
Hudson, WI 54016
Telephone - (715)386-4680
The St. Croix counttZoning of f o Lending e, Rservice of septic
ealty Firms, and
and water inspections g institutions,
private individuals.
Completion 2f this form J. essential ,gQ ghat #.~lg Rroperty gAII h
located.
Please provide the following information, enclose appropriate
fee made payable to St. Croix County Zoning office, and mail,
along with form to the above address. Testing will be done as
soon as possible after fee and form are received. j /
WATER TESTING----------------------------FEE: $ 35.00 y
(For nitrates and coliform bacteria)FEE: $185.00
WATER TESTING
(For VOCIS) FEE: $25.00
SEPTIC SYSTEM INSPECTION-----------------
(Determines if system is properly functioning at.,time of
inspection)
LLP-q
PROPERTY OWNER'S NAME:
PROP. ADDRESS:- CIT
Legal Desc tion 1/4 of the 1/4 of Section , T N-RLL_
Town of Lo Number Subdivision: C Q25_
172 7 F jr~
o~
FIRE NUMBER LOCK $Qx
Color of house Realty sign by house? If so, list firm:
PLEASE INCLUDE, IF AT ALL POSSIBLE, A NAP,i.e,COPY OF PLAT BOOK,
WITH LOCATION SHOWN, AND A COPY OF THE LISTING SHEET.
Testing of residential water requires a sample that is fresh. If
the home is vacant, and has been so for some time, the water line
must be purged by running the water for several hours before the
test can be conducted.
WINTER TESTING: Many times water lines are turned off, or sill
cocks are turned off, making access to the home necessary. If
this is the case, please make proper arrangements with this
office to ensure time when entry may be gained.
Firm or individual r Vesting services:
Telephone Number ~S- - N
O
r_-g5r Ar J~"
REPORT TO BE SENT TO:
2S ,eEC_ Bg~
CLOSING DATE:
Signature
aC- z~(~s
4
f._ t
ST. CROIX COUNTY
WISCONSIN
ZONING OFFICE
ST. CROIX COUNTY COURTHOUSE
' - 911 FOURTH STREET • HUDSON, WI 54016
(715) 386-4680
May 12, 1992
Terry Flancha,
368 Glover Rd'.!41'
Hudson, WI 54016
Dear Ms. Flancha:
An inspection of the septic system on the property of Terry
Flancha, located at 368 Glover Rd., Hudson, WI was conducted on May
12, 1992. At the same time a water sample was obtained for
testing. The results of that testing will be sent to you as soon
as we receive them back from the laboratory.
At the time of inspection, the sanitary system appeared to be
functioning properly. The inspection of this sewage disposal
system was based upon a surface inspection of said system, and did
not involve any excavating or chemical analysis. Accordingly,
there is the possibility of hidden defects in the system not
discoverable by this inspection. This does not in any way warrant
or guarantee the continued proper functioning or operation of this
system. It is recommended that the system should be pumped once
every three years. Therefore, the prolonged life of this system
may be dependent upon proper maintenance of the system.
sincerely,
Mar ,Ven in
Assistant Zoning Administrator
cj
~ ~r